Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 03262 | Date 22/10/2019 |
| Token No | SM/18-19/7104 22/10/2019 | Serial | 019 |
| Patient Name | Miss ATRIYA GHOSH | Contact No | 7044127241 |
| Address | 2 SAHIBHUSAN GHOSH LANE | Age | 12 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||